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This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Resumen Este documento de posicionamiento, auspiciado por la Asociacion Espanola de Gastroenterologia, la Sociedad Espanola de Endoscopia Digestiva y la Sociedad Espanola de Anatomia Patologica, tiene como objetivo establecer recomendaciones para realizar una endoscopia digestiva (EDA) de calidad en la deteccion y vigilancia de lesiones precursoras de cancer gastrico (LPCG) en poblaciones con incidencia baja, como la espanola. Para establecer la calidad de la evidencia y los niveles de recomendacion se ha utilizado la metodologia basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un metodo Delphi. El documento evalua diferentes medidas para mejorar la calidad de la EDA en este contexto y hace recomendaciones de como evaluar y tratar las lesiones identificadas. Se recomienda que la EDA de vigilancia de LPCG sea realizada por endoscopistas con capacitacion adecuada, administrando premedicacion oral y uso de sedacion. Para mejorar la identificacion de LPCG se recomienda el uso de endoscopios de alta definicion y cromoendoscopia convencional o digital, y para las biopsias debe utilizarse el NBI para dirigirlas a las areas mas sospechosas de metaplasia intestinal. En cuanto a la evaluacion de las lesiones visibles, el riesgo de invasion de la submucosa debe evaluarse con endoscopios de magnificacion y reservar la ecoendoscopia para aquellas con sospecha de invasion profunda. En las lesiones susceptibles de reseccion endoscopica, la diseccion endoscopica submucosa se considera la tecnica de eleccion.

Resumen Este documento de posicionamiento, auspiciado por la Asociacion Espanola de Gastroenterologia, la Sociedad Espanola de Endoscopia Digestiva y la Sociedad Espanola de Anatomia Patologica, tiene como objetivo establecer recomendaciones para el cribado del cancer gastrico (CG) en poblaciones con incidencia baja, como la espanola. Para establecer la calidad de la evidencia y los niveles de recomendacion se ha utilizado la metodologia basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un metodo Delphi. El documento evalua el cribado en poblacion general, individuos con familiares con CG y lesiones precursoras de CG (LPCG). El objetivo de las intervenciones debe ser la reduccion de la mortalidad por CG. Se recomienda el uso de la clasificacion OLGIM y determinar el subtipo de metaplasia intestinal (MI) para evaluar las LPCG. No se recomienda establecer cribado poblacional endoscopico de CG ni de Helicobacter pylori. Sin embargo, el documento establece una recomendacion fuerte para el tratamiento de H. pylori si se detecta la infeccion, y su investigacion y tratamiento en individuos con antecedentes familiares de CG o con LPCG. En cambio, no se recomienda el uso de test serologicos para detectar LPCG. Se sugiere cribado endoscopico unicamente en los individuos con criterios de CG familiar. En cuanto a los individuos con LPCG, solo se sugiere vigilancia endoscopica ante MI extensa asociada a algun factor de riesgo adicional (MI incompleta y/o antecedentes familiares de CG) tras la reseccion de lesiones displasicas o en pacientes con displasia sin lesion visible tras una endoscopia digestiva alta de calidad con cromoendoscopia.

Background Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5–9 mm polyps in terms of complete resection and adverse events. Methods This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5–9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without 9 mm polyps. Results 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval –1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01). Conclusions We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.

Data de publicació electrònica: 14-03-2022 Background: Colonoscopy is the gold standard method for the early diagnosis and prevention of colorectal cancer (CRC). Screening programs include immune determination of blood in faeces. Regardless of the method used, proximal colon lesions appear to be detected less frequently. Objective: analyse the characteristics of proximal and distal lesions and possible predisposing factors. Methods: We made a cross-sectional study of 692 patients from the CRC screening program with FIT ≥ 100ngHb/ml (October 2017 - October 2018). The right colon was examined twice as patients were participating in a randomized clinical trial to re-evaluate the right colon by forward-viewing endoscope or proximal retroflexion. The adenoma detection rate (ADR), advanced neoplasia (AN) and CRC in the proximal and distal colon, the histological and morphological characteristics in each section were analysed. Results: Patients were 52.9% male, a mean age of 59.5 years (SD: 7.6). We found 1490 polyps. The ADR was 57.7% (distal 42% and proximal 37%). Detection rates were 45.8% for AN, 40.9% for advanced adenomas, 5.2% for advanced SSL and CRC was diagnosed in 4.8% of patients. Males had more AN than females. The mean age of patients with AN was significantly higher. AN were associated with smoking and alcohol consumption (p=0.0001). Globally, FIT levels were higher in patients with AN (p=0.003). Sixty-six per cent of cancers were distally located and 61.3% of CRC were diagnosed in the early stages. Conclusions: In an average-risk asymptomatic population undergoing colonoscopy after positive FIT, AN were more common in the distal colon in males, older patients, smokers, and those with alcohol intake.

Introduccion: la pandemia mundial por SARS-CoV-2 obligo a paralizar las unidades de endoscopia. Previamente a la reanudacion de la actividad endoscopica disenamos un protocolo de valoracion de gastroscopias y colonoscopias, desprogramadas durante la pandemia, denegando las no indicadas y priorizando las indicadas. Metodos: establecimos dos tipos de denegacion: a) contexto covid-19 en ≤ 50 anos sin sintomas de alarma y baja probabilidad de hallazgos endoscopicos relevantes; y b) contexto inadecuado por no ser acordes con las guias o protocolos clinicos. Las denegaciones se archivaron en la historia clinica del paciente. Clasificamos las adecuadas en preferentes, convencionales y seguimiento. Comparamos las denegadas por especialidad. Valoramos los hallazgos de las preferentes. Resultados: valoramos 1.658 peticiones (44 % gastroscopias, 56 % colonoscopias) entre el 16 marzo y el 30 junio de 2020. Se consideraron adecuadas 1.164 (70 %), de ellas preferentes el 8,5 %, convencionales el 48 %, seguimiento el 43 % y no valorables el 0,5 %. Se denegaron 494 (30 %): 20 % “contexto covid-19” y 80 % “contexto inadecuado”. Los motivos de denegacion en las gastroscopias fueron: seguimiento de lesiones (33 %), sintomas insuficientemente estudiados (20 %) y sintomas recidivantes con gastroscopia previa (18 %). Los motivos de denegacion en las colonoscopias fueron: vigilancia pospolipectomia (25 %), cancer colorrectal intervenido (21 %) y antecedentes familiares de cancer (13 %). Encontramos diferencias significativas en la denegacion segun la especialidad: Cirugia General (52 %), Hematologia (37 %) y Atencion Primaria (29 %). Un 31 % de las preferentes mostraron hallazgos relevantes. Conclusiones: un 24 % de nuestras endoscopias son discordantes con las recomendaciones cientificas. Su denegacion y la priorizacion de las adecuadas optimizan la utilizacion de recursos.

This positioning document, sponsored by the Asociacion Espanola de Gastroenterologia, the Sociedad Espanola de Endoscopia Digestiva and the Sociedad Espanola de Anatomia Patologica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.

BACKGROUND: Colonoscopy is the gold standard investigation for the detection of colorectal cancer, but the right colon is more difficult to examine than the left colon. A second examination of the proximal colon has the potential to reduce rates of missed pathology. OBJECTIVE: To determine whether proximal retroflexion improves the adenoma detection rate or other outcomes in the right colon compared with the forward view. METHODS: We performed a multicentre randomized controlled trial of patients from the colorectal cancer screening programme with a positive faecal immunochemical test. Patients were randomized to a second right colon examination using proximal retroflexion or forward view. RESULTS: A total of 692 patients were included. A second examination of the right colon, with an average additional procedure time of 1.62 min, increased the adenoma detection rate by 11%, regardless of the method used (9% proximal retroflexion vs. 12% second forward view, p = 0.21). The adenoma miss rate was 19% (17% proximal retroflexion vs. 20% forward view, p = 0.28) The success rate of retroflexion was 83%, without secondary complications. In the 15.6% of patients in whom lesions were detected during the second pass, endoscopic follow-up was modified by reducing the time of the next colonoscopy. CONCLUSIONS: A second examination of the right colon, either from retroflexion or second forward view, can increase adenoma detection rate and shorten surveillance intervals in patients undergoing screening colonoscopy. This should be emphasized during colonoscopy training and integrated into diagnostic colonoscopy practice.

The intestinal spirochaetosis is defined as the presence of spirochetes on the colonic surface. We present the case of a 57-years-old male, with a history of 4-5 months of diffuse abdominal pain, watery diarrhoea due to this infection. The colonoscopy revealed a serpiginous ulcer in the cecum. The biopsy was positive for intestinal spirochaetosis. It is rare infection, more common among immunocompromised patients and HIV, with a faecal-oral transmission. Most cases are incidental findings in the endoscopic screening. In symptomatic patients the watery diarrhoea and non-specific abdominal pain are the most common symptoms. The macroscopic appearance on the colonoscopy is often normal or non-specific lesions can be identified. The diagnosis is based on the biopsy with haematoxylin and eosin and the confirmation can be made with a Warthin-Starry stain. In symptomatic patients the metronidazole is the preferred treatment option. Although it is rare infection, clinicians should be aware of it in patients with common gastrointestinal symptoms.

Supplemental material, sj-pdf-1-ueg-10.1177_2050640620924210 for Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial by Ma Henar Núñez Rodríguez, Pilar Díez Redondo, Fausto Riu Pons, Marta Cimavilla, Luis Hernández, Andrea Loza and Manuel Pérez-Miranda in United European Gastroenterology Journal

Background & Aims Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. Methods We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Results Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). Conclusions Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Background: satisfaction with healthcare is focused on the patient and is known as “patient-centered care”. However, user satisfaction is not always synonymous with good care. Healthcare practitioners should determine and understand what patients need and expect in order to improve the quality of care. Aims: the main objective of this study was to determine the perceived quality of care of patients diagnosed with colorectal cancer in our unit. Methods: a cross-sectional study was performed in all patients diagnosed with colorectal cancer (CRC) that underwent staging studies and were hospitalized in the Gastroenterology Department from May 2013 to October 2013. Furthermore, outpatients with rapid consultations for CRC staging from November 2013 to November 2014 were also included. Two questionnaires were administered: a) a survey of 20 questions with closed responses regarding the competence of treating physicians and nurses, the information received and the waiting time; b) the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25: information on the disease, medical tests, treatment and other services, with eight single items. Results: there were no differences in the perceived healthcare quality, delays in starting treatment, the tumor stage, symptoms (performance status) or the time spent studying the disease. In-patients and those with advanced disease started treatment earlier than outpatients and those with disease stage I or II. Likewise, outpatients perceived a better psychological support. Conclusions: outpatient study did not reduce the quality of care and did not delay treatment.

Primary squamous cell carcinoma (SCC) of stomach is a rare disease. There are fewer than 100 cases published in the literatura. The pathogenesis remains to be elucidated and the prognosis is poor. In the case presented here, clinical, endosopy, histopathological examination and staging are described; However, the outcome was bad and the patient died 6 months later.

Secondary Aorto-enteric fistula (SAEF) is a communication between the aorta and the intestines which occurs in a setting prior aortic surgery such as abdominal aortic aneurism (AAA) repairing. Gastrointestinal bleeding and abdominal pain have been described in the majority of cases. SAEF is a rare and life-threatening complication so a high degree of clinical suspicion is necessary for diagnosis.

T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node).We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy.Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P.001). However, pedunculated morphology (P.007), ulceration (P = .026), depressed areas (P.001), or nodular mixed type (P.001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable.In an analysis of 2123 colon lesions10 mm, we found the NICE classification and morphologic features identify those with deep lesions with96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.

Dendritic cells (DCs) control the type and location of immune responses. Ulcerative colitis (UC) is considered a Th2 disease mediated by IL-13 where up to one third of patients can develop extraintestinal manifestations. Colonic biopsies from inflamed and noninflamed areas of UC patients were cultured in vitro and their supernatants were used to condition human blood enriched DCs from healthy controls. Levels of IL-13 in the culture supernatants were below the detection limit in most cases and the cytokine profile suggested a mixed profile rather than a Th2 cytokine profile. IL-6 was the predominant cytokine found in inflamed areas from UC patients and its concentration correlated with the Mayo endoscopic score for severity of disease. DCs conditioned with noninflamed culture supernatants acquired a regulatory phenotype with decreased stimulatory capacity. However, DCs conditioned with inflamed culture supernatants acquired a proinflammatory phenotype with increased expression of the skin-homing chemokine CCR8. These DCs did not have decreased T-cell stimulatory capacity and primed T cells with the skin-homing CLA molecule in an IL-6-dependent mechanism. Our results highlight the role of IL-6 in UC and question the concept of UC as a Th2 disease and the relevance of IL-13 in its etiology.

Beclometasone dipropionate (BDP) is a relatively new topically acting oral steroid to treat mild to moderately active ulcerative colitis (UC). We estimate that 20,000 patients have received oral BDP in Spain in the last two years. Our aim was to evaluate the efficacy and safety of oral BDP in clinical practice.Retrospective and multicenter study that included 434 patients with active UC treated with BDP. The partial Mayo Clinic score (pMS, 0-9) was used to measure disease activity. Remission was defined as post-treatment pMS of 0 or 1; response as a decrease in pMS of 3 points or 2 points and30%, and failure as lack of remission or response.BDP dose was 5 mg/day in 88% of patients and mean treatment duration was 6.2 weeks. BDP achieved remission in 44.4%, response in 22.3% and failed in 33.2% of patients. Mean pMS decreased from 4.9 ± 1.3 to 2.4 ± 2.3 (p0.0001). Remission rate was higher in mild and moderate than in severe UC (p0.043) and tended to be higher in left-sided and extensive UC than in proctitis (p0.06). Failure was less frequent in patients treated for4 weeks (p0.02). Mild adverse events were reported in 7.6% of patients.BDP induces response or remission in two thirds of active UC patients, with a good safety profile. Patients with mild to moderate, left-sided or extensive UC, receiving BDP for more than 4 weeks are most likely to benefit from this treatment.

Background An association between psychological factors and gastroesophageal reflux disease has been recognized. Psychological distress can influence the outcomes of the disease. Aims To determine the existence of psychological factors in our gastroesophageal reflux disease sample, as well as determine their influence on the outcome of the disease and treatment response. Methods A cross-sectional study was performed from February 2006 to December 2007. Patients referred to gastrointestinal specialists who reported symptoms of gastroesophageal reflux were asked to fill out the SCL-90-R questionnaire. All underwent endoscopy and pH-metry studies. Results Fifty-five patients with gastroesophageal reflux disease were analyzed. Subjects with reflux symptoms had higher scores compared to healthy controls on sommatization, obsessiveness, interpersonal sensitivity, being phobic, being psychotic, and the global index (P < 0.05). Patients with high frequency of symptoms and long duration of disease have increased psychological distress. There was no relationship among pH-metry results, endoscopy findings, and SCL-90-R scores. Conclusions Psychosocial factors can predispose to gastroesophageal reflux disease. The SCL-90-R questionnaire can be useful in investigating psychological factors in those patients with unsuccessful outcome of the symptoms despite correct management.

An 82-year-old male with a history of high blood pressure, COPD, chronic myeloid leukemia, and stage-4 chronic renal failure. Admitted to hospital for lower-limb cellulitis and severe COPD exacerbation, he received antibiotic therapy and bronchodilators. During his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. A complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleeding stigmata and submucosal bleeding suggestive of infectious colitis; stool culture was negative and Clostridium difficile toxins were positive. The condition was histologically confirmed.

Introduccion: Las tecnicas convencionales para el diagnostico cito-histologico de las lesiones subepiteliales gastrointestinales (LSEGI) presentan limitaciones. La PAAF por ecoendoscopia aporta escaso material, especialmente en lesiones pequenas o de origen mesenquimal que precisan analisis inmunohistoquimico (IH). La incision con esfinterotomo de aguja y biopsia con pinza (IEA-BP) guiada por ecoendoscopia, es una tecnica de reciente desarrollo, con resultados iniciales prometedores Objetivo: Analizar las caracteristicas de las LSEGI del tracto digestivo superior valorando rendimiento diagnostico y seguridad de la IEA-BP en su estudio cito-histologico. Material y Metodo: Entre abril 2010- junio 2013 se recogieron prospectivamente todas las LSEGI. Se valoro morfologia y vascularizacion con ecoendoscopio sectorial/doppler, realizandose una incision superficial de 6 mm, con EA y potencias 30 – 60 W, introduciendose pinza convencional de biopsia, extrayendose 3 – 5 muestras para formol. En las lesiones mesenquimales se realizo IH y determinacion de indice mitotico (IM). En 8 pacientes se realizo simultaneamente PAAF-22G. Se definieron como lesiones “pequenas”: O < 20 mm. Resultados: Se incluyeron 61 pacientes (V/M: 30/31). Edad media 60.05 anos (22 – 89). Diametro medio: 2.31 cm (0.65 – 9.31). Localizacion: Esofago/estomago/duodeno: 4/51/6. Capa: 2a/3a/4a: 5/29/27. Etiologia: GIST: 21, pancreas ectopico: 11, lipoma: 7, leiomioma: 3, polipo fibroide: 6, otras: 5, no diagnostica: 8. Rendimiento global: 53/61: 86.88%. Lesiones pequenas/grandes: 30/31: rendimiento pequenas: 25/30 (83.33%): rendimiento grandes: 28/31: 90.32% (p < 0.02). La PAAF solo resulto diagnostica en 1/8 casos (12.5%).. El analisis IH (CD 117/CD 34) fue factible en 20/21 GIST (95.23%) y para IM en 16/21 (76.19%). No existieron complicaciones. Conclusiones: La IEA-BP asistida por ecoendoscopia es una tecnica segura y de alto rendimiento en el estudio de las LSEGI incluso en aquellas de menor tamano, constituyendo una alternativa eficaz a la PAAF